Abstract 18625: Mismatch Between Right and Left Sided Filling Pressures in Heart Failure Patients With Preserved and Reduced Ejection Fraction
Introduction: Elevated jugular venous pressure (JVP) is one of the most important physical signs of elevated left-sided filling pressure in patients with congestive heart failure (HF). However, treatment guided by JVP can frequently be inappropriate in patients with mismatch between right- and left-sided filling pressures (R-L mismatch). Little is kwon about R-L mismatch in general HF population, especially in HF patients with preserved ejection fraction (HFpEF). Moreover, prognostic impact of R-L mismatch has not been fully elucidated in these patients.
Methods: HF patients who underwent right side heart catheterization were prospectively enrolled. Right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were classified as elevated when ≧10mmHg and ≧22mmHg, respectively. Correlation of RAP and PCWP and its prognostic value were investigated in HFpEF (≧40%) and HFrEF patients.
Results: A total of 316 HF patients were enrolled. Mean age was 70±12 years, ischemic etiology was 26%, and HFpEF was 57%. In HFpEF patients, low match and high-R mismatch were more common, while high match and high-L mismatch were less common than in HFrEF patients (low match, 77% vs. 70%, high match, 6.7% vs. 15%, high-R mismatch, 11% vs. 3.7%, and high-L mismatch, 5.6% vs. 12%, in HFpEF and HFrEF patients, p=0.002). Elevated PCWP was a significant predictor for composite of death or HF hospitalization in 180 days (adjusted HR 6.23, 95% CI 3.07-12.7, p<0.001). Additional predictive value of elevated RAP was not determined (Figure). Pulmonary artery systolic pressure (PASP) showed stronger correlation with PCWP than RAP (r=0.81, p<0.001, vs. r=0.62, p<0.001).
Conclusions: Discordance exists between RAP and PCWP in both HFpEF and HFrEF patients. In these patients, decongestion therapy guided by elevated JVP can lead to over or under treatment. Physicians may utilize other clinical findings including RASP to maintain PCWP, which is a significant predictor of prognosis in HF.
Author Disclosures: Y. Horiuchi: None. S. Tanimoto: None. H. Kadowaki: None. T. Okuno: None. T. Kinoshita: None. M. Izumo: None. J. Aoki: None. H. Nakajima: None. K. Hara: None. K. Tanabe: None.
- © 2016 by American Heart Association, Inc.